Endocrine Abstracts

Introduction: Primary tubercular pituitary abscess is an extremely rare disease. Only few cases had been reported and the diagnosis was reached only after surgery. There is a need to distinguish between a tuberculoma, pituitary abscess and other functioning and nonfunctioning pituitary adenoma to direct our management into either medical or surgical management, especially here in the Philippines where tuberculosis is an endemic disease.

Case: We present a case of a 50-years-old diabetic Filipina who came in for complains of gradual loss of vision, bitemporal, since four months prior to admission. This was associated with frequent headaches, polydipsia and polyuria. No previous history of pulmonary tuberculosis. Physical examination and vital signs were normal except for hemianopsia. Chest X-ray was normal. Perimetry exam revealed temporal hemianopsia on the right, and almost complete temporal anopsia, left. MRI showed a relatively large 2.8 cm cystic-appearing mass involving the sellar and suprasellar compartments compatible with a cystic adenoma or a craniopharyngioma. Serum FT₄ was 10.5 pmol/l (11–24), TSH 1.4 mIU/l, serum prolactin 2404.2 mIU/l (90–500) and serum cortisol at 409.8 nmol/l (154–638). The patient underwent transphenoidal pituitary surgery and intraoperatively the sellar floor was noted to be thinned out with noted egress of a purulent material during opening of the dura. Staining of the purulent material was positive for acid fast bacilli. Anti Kochs medication was started, together with vancomycin and cefepime. Postoperatively, patient developed diabetes insipidus, but there was significant improvement in vision.

Learning points: Always consider tubercular pituitary abscess in a diabetic patient living in a tuberculosis endemic area and presenting with a sellar suprasellar mass.

MRI of the brain showing a 2.8 cm cystic mass involving the sellar and suprasellar compartments causing severe compression of the overlying optic apparatus.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.